NASM WFS cheat sheet

Women's Fitness Specialization: Physiology, Assessment, and Program Design

• The female athlete triad describes the interrelationship of low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density; Relative Energy Deficiency in Training (RED-S) is the broader model that adds effects on immunity, protein synthesis, cardiovascular health, and psychological state.

• Menstrual cycle physiology: the follicular phase is dominated by rising estradiol with low progesterone; ovulation occurs near mid-cycle under an LH surge; the luteal phase features elevated progesterone and, in many women, a 0.3-0.5 C rise in basal body temperature that persists until menses.

• Practical cycle-based programming: many women report lower perceived exertion and better recovery in the late follicular phase, and higher perceived effort, fluid retention, and thermal strain in the late luteal phase; these are population tendencies, so individual tracking (symptom log, RPE, HRV) overrides calendar-based assumptions.

• Bone-loading rule: because peak bone mass is largely accrued by the late 20s, programming should include progressive axial loading (resistance training, impact/plyometric work) and adequate calcium and vitamin D; low energy availability blunts bone formation regardless of training load.

• Pelvic floor: the levator ani and coccygeus support pelvic organs; risk factors for dysfunction include pregnancy, vaginal delivery, high-impact loading, chronic coughing, and heavy lifting with breath-holding; first-line conservative management is supervised pelvic floor muscle training, and symptoms (leakage, heaviness, pain) warrant referral.

• Pregnancy exercise guidance (ACOG-consistent): in uncomplicated pregnancies, accumulate about 150 minutes per week of moderate-intensity aerobic activity plus light-to-moderate resistance work; avoid supine exercise for prolonged periods after the first trimester, contact sports, activities with fall risk, and exercise at altitude; stop and seek care for vaginal bleeding, fluid leakage, regular painful contractions, dizziness, or chest pain.

• Diastasis recti (interrectus distance) is a widening of the linea alba common in pregnancy and postpartum; assessment uses a supine curl-up with finger measurement above, at, and below the umbilicus; training emphasizes deep abdominal and pelvic floor coordination, breathing, and progressive loading rather than avoidance of all flexion.

• Menopause physiology: declining estradiol and inhibin raise FSH; hot flashes, sleep disruption, and reduced vasomotor control affect training tolerance; resistance and weight-bearing training plus adequate protein help counter the accelerated loss of bone and lean mass in the early postmenopausal years.

• Screening and referral decision rule: a positive screen for disordered eating, amenorrhea lasting 3 or more months, stress fracture history, incontinence, or pelvic pain exceeds a fitness professional's scope; document and refer to the appropriate physician, registered dietitian, or pelvic health physical therapist.